Leptospirosis: challenges in diagnosis, and predictors of severity

Rajapakse, Senaka; Fernando, Narmada; Niloofa, M.J.R.; Silva, H. J. De; Karunanayake, Lilani; Premawansa, Sunil; Handunnetti, Shiroma

doi:10.4038/jccp.v47i2.7785

Cited by 5 publications

(10 citation statements)

References 33 publications

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“…Thus, after subsequent cell membrane damage, fluidity declines, and extracellular permeability increases. This result is consistent with those reported by other researchers 14,15,20 . Two other studies showed no significant differences in the MDA concentrations between patients with severe and mild leptospirosis infections, which is likely because serum MDA concentrations are not good indicators of lipid peroxidation since lipids are primarily located in tissues 14,15 .…”

Section: Discussionsupporting

confidence: 92%

“…In more severe cases, higher production of free radicals is present. With the increase in oxidative products, more antioxidants will be consumed, resulting in a reduction in total antioxidant concentrations throughout the body 14,15 . The findings observed in this study mirror the serum TAC concentrations in previous studies that have examined the effects of leptospiral infection in dogs 29 and cats 30 .…”

Section: Discussionsupporting

confidence: 80%

“…The membrane compounds of Leptospira interrogans induce the expression of iNOS‐induced enzymes in the proximal renal tubules and vascular endothelium, which ultimately catalyze the NO radical produced from L‐Arginine. Thus, changes in NO concentrations and function are expected 15,20,41 . Subsequently, NO concentrations in animals with leptospiral antibody titers of 1:200 and above were significantly higher than in animals with antibody titers of 1:100.…”

Section: Discussionmentioning

confidence: 94%

“…Oxidants are unstable molecules that can damage all biological molecules and cause severe sequela, including genetic mutations, cancer, and cellular apoptosis or necrosis 11 . The most important oxidants in mammalian bodies are reactive oxygen species (ROS) and reactive nitrogen species 4,12‐15 . Oxidative processes are important because they can control free radical production.…”

Section: Introductionmentioning

confidence: 99%

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The effect of natural infection with differentLeptospira interrogansserovars on oxidative stress biomarkers and acute‐phase responses in horses and cattle

Niroomandi

Maleki

Abdollahpour

et al. 2022

Veterinary Clinical Pathol

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Leptospirosis is one of the important zoonotic bacterial diseases with a worldwide distribution that is often subclinical. We aimed to investigate the oxidant/antioxidant balance and acute‐phase response in naturally infected horses and cattle with Leptospira interrogans. A total of 600 serum samples from horses and cattle were examined for L. interrogans antibodies using the microscopic agglutination test to determine anti‐Leptospira IgG antibodies against a panel of eight important Leptospira antigens in Iran. Then, serum total antioxidant capacity, catalase, glutathione peroxidase, and malondialdehyde activities, and nitric oxide, total protein, serum amyloid A, haptoglobin, and albumin concentrations were measured in seropositive and seronegative samples. Serum catalase activities and malondialdehyde, serum amyloid A, and haptoglobin ‌concentrations in seropositive cattle and horses were significantly higher (P < .05) than in those that were seronegative. Antibody titers increased from 1:100 to ≥1:200 in cattle with L. interrogans infection, resulting in a decrease in the serum total antioxidant capacity (P < .05), an increase in serum glutathione peroxidase (P < .01) activity and nitric oxide (P < .05) , serum amyloid A (P < .01), and haptoglobin (P < .05) concentrations. Following the increase in the agglutinating antibody titers in horses infected with L. interrogans, the serum total antioxidant capacity (P < .01) decreased, and serum nitric oxide (P < .05), malondialdehyde (P < .05), and serum amyloid A (P < .01) concentrations were increased. In this study, horses and cattle had extensive changes in oxidant/antioxidant equilibrium and acute‐phase protein concentrations when infected with L. interrogans. We also demonstrated a direct link between antibody titers and the type of leptospiral serovar using serum oxidative and inflammatory markers.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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The effect of natural infection with differentLeptospira interrogansserovars on oxidative stress biomarkers and acute‐phase responses in horses and cattle

Niroomandi

Maleki

Abdollahpour

et al. 2022

Veterinary Clinical Pathol

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“…Severe leptospirosis: "Patients with any of the following were categorized as having severe leptospirosis; jaundice (bilirubin>51.3 µmol/L), renal insu ciency (oliguria with a urine output less than 400 ml per day or creatinine > 133 µmol/L or blood urea > 25.5 mmol/L), and other indicators of poor outcome (intensive care unit stay, initiation of dialysis, hospital stay greater than 10 days and multi-organ dysfunction" [29]. Shock: a systolic blood pressure below 90 mmHg or mean arterial pressure below 70 mmHg and requirement for vasopressors.…”

Section: De Nitionsmentioning

confidence: 99%

Determinants of prolonged hospitalization and mortality among leptospirosis patients attending tertiary care hospitals in northeastern state in Peninsular Malaysia: A cross sectional retrospective analysis

Hariri¹,

Sulaiman²,

Khan³

et al. 2021

Preprint

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Objectives Leptospirosis is the most common anthropozoonosis worldwide and imposes a major public health problem in many tropical countries. It is a leading cause of disease burden in form of mortality, morbidity and hospital admission. Identifying patients at high risk for mortality or for prolonged hospitalization may save lives and preserve economy. The aim of the current study was to identify significant factors associated with disease mortality and prolonged hospitalization.Design Cress-sectional retrospective studySettings Tertiary care teaching hospitals in Kelantan, Peninsular Malaysia Participants Adult patients proven to have leptospirosis depending on IgM ELISA were classified into two classes depending on prolonged hospitalization (>7 days or ≤ 7 days) and mortality (fatal cases or non-fatal cases). Patients’ clinico-laboratory data were compared according to these two outcomes using the appropriate statistical test accordingly.Results Of the 525 patients enrolled, 136 (25.9%) had prolonged hospitalization. The mean length of stay was 6.77 ± 5.68 days. Logistic regression analysis identified acute kidney injury (AKI) (OR 2.3), Jaundice (OR 2.7), elevated alanine aminotransferase (ALT) (OR 2), and prolonged prothrombin time (PT) (OR 1.9) independently associated with prolonged hospitalization. Case fatality rate was 6.48% and around one third of fatal cases had prolonged hospitalization of more than seven days. Factors associated with leptospirosis mortality included age > 40 years (p<0.001), patients presented with tachypnea (p=0.002), pulmonary infiltrate (p<0.001), T-wave changes (p<0.001), atrial fibrillation (p=0.013), conducting abnormality (p<0.001), chronic kidney diseases (p<0.001), multiple organ dysfunctions (p<0.0010), respiratory failure (p<0.001), pneumonia (p<0.001), sepsis (p=0.004), low venous PH (p=0.042), AKI (P<0.001), elevated AST (p<0.001) or ALT (p=0.004), hypoalbuminemia (p<0.001), rhabdomyolysis (p<0.001), severe thrombocytopenia (p=0.042), prolonged PT (p<0.001) or prolonged aPTT (p<0.017).Conclusions Significant proportion of leptospirosis patients (25.9%) had prolonged hospital stay and less proportion died (6.48%). Early identifying patients with factors associated with prolonged hospitalization and death will positively impact practitioners’ decisions regarding the proper and fast course of management including ICU admission

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Estimating the burden of leptospirosis in Sri Lanka; a systematic review

2019

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BackgroundAlthough the assessment of disease burden should be a priority for allocating resources, leptospirosis is grossly underestimated despite its true burden in Sri Lanka. This study aimed to assess the morbidity and mortality of leptospirosis based on routine surveillance data, hospital reported data and scientific publications from Sri Lanka.MethodA systematic review was carried out, and Pub Med, MEDLINE®, BIOSIS Previews, Zoological Record, Web of Science Core Collection, Current Contents Connect, KCI-Korean Journal Database, BIOSIS Citation Index, Data Citation Index, SciELO Citation Index and Google Scholar databases were searched. Quarterly epidemiological bulletin (QEB), indoor morbidity & mortality returns (IMMR) and hand searches of local literature were performed in local libraries. Forty-two relevant full texts, 32 QEBs, and 8 IMMR were included in the full text review. Adjustments were made for under diagnosis, underreporting and chance variability.ResultsThe estimated annual caseload of leptospirosis in Sri Lanka from 2008 to 2015, was 10,423, and the cumulative annual incidence of leptospirosis that required hospitalization was 52.1 (95% CI 51.7–52.6) per 100,000 people. The estimated number of annual deaths due to leptospirosis was approximately 730 (95% CI 542–980), with an estimated pooled case fatality ratio of 7.0% (95% CI 5.2–9.4). The most common organs involved were the kidney, liver and heart, with median rates of 48.7, 30, and 14.2%, respectively.ConclusionOur systematic review shows gross underestimation of the true leptospirosis burden in the national statistics of Sri Lanka, and the hospitalization rates estimated in our study were compatible with the total burden estimate of 300·6 (95% CI 96·54–604·23) per 100,000 people published previously.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3655-y) contains supplementary material, which is available to authorized users.

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Leptospirosis: challenges in diagnosis, and predictors of severity

Cited by 5 publications

References 33 publications

The effect of natural infection with differentLeptospira interrogansserovars on oxidative stress biomarkers and acute‐phase responses in horses and cattle

The effect of natural infection with differentLeptospira interrogansserovars on oxidative stress biomarkers and acute‐phase responses in horses and cattle

Determinants of prolonged hospitalization and mortality among leptospirosis patients attending tertiary care hospitals in northeastern state in Peninsular Malaysia: A cross sectional retrospective analysis

Estimating the burden of leptospirosis in Sri Lanka; a systematic review

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